156263 02/06/2008 q wf CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $165.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 156263
CHECK DATE: 2/612008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
I
1201 R4358800-16631 143473 55.00 DRUG TESTING
1201 R4358800 16631 144034 110.00 DRUG TESTING
I
'i
Midwest Toxicofogy Invoic
DATE INVOICE
W wi i i 603 East Washington Street, Suite 200, Indianapolis, IN 46204 1 /29/2008 143473
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
JDT
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test M... Non -DOT Drug Test at Midwest Indy 55.00 55.00
1/25/08
Pay your bills online at:
https://www.intuitbiIIpay.com/midwesttoxicologyservicesinc.
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
For the purpose of client confidentiality we are no longer showing the full SSN on invoices. Total $55.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contuct_us at 317- 262 -2200 or fax us at 317- 262
Be sure to visit our website at www.midwesttoxicology.com.
1
Prescribed bttate Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Midwest Toxicology
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/29/08 143473 Non -DOT Drug Test at Midwest $55.00
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER V-104108WARRANT NO.
io I Wes OXICO Ogy ALLOWED 20
03 E. Washington St., Suite 200 IN SUM OF
Indianapolis, I4 11—
$55.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
16631 bill(s) is (are) true and correct and that the
pa is 88 $55.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
ignat e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
F
Midwest 7oXicoCogy Invoi
ow DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 2/1/2008 144034
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
MG
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
2 ND Drug Test CS Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center Carmel, IN
1/30/08
Pay your bills online at:
https://www.intuitbi11pay.com/midwesttoxicologyservicesinc.
I
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
For the purpose of client confidentiality we are no longer showing the full SSN on invoices. Total $110.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317 262 -2200 or fax us at 317- 262 -2222.
Be sure to visit our website at www.midwestioxicology.coni.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Midwest Toxicolo ftyee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
144034 Non -DPT Drug Test collected at Community Occ Health $110
Center Indiana (2)
Total
0
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER IQ. /0 /ag_WARRANT NO.
I WeS OXICO Og HA LLOWED 20
603 E. Washington St., Suite 200 IN SUM OF
Ind ianapolis 1 4 1 46—:204
$110.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
16631 bill(s) is (are) true and correct and that the
pa is $110.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sipatare
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund